System and method for planning and performing a repeat interventional procedure

ABSTRACT

A system for planning and performing a repeat interventional procedure is provided which includes a registration device ( 116 ) and an image generation device ( 120 ) which map current targets in a reference image ( 104 ) for a first interventional procedure to at least one guidance image ( 112 ) acquired from a different imaging modality. Biopsy locations are recorded to the guidance images during the first interventional procedure and the biopsy locations are mapped to the reference image to provide a planning image for use in a subsequent interventional procedure on the patient. In a subsequent interventional procedure, the prior planning image ( 124 ) may be registered to a current reference image ( 126 ) and the prior biopsy locations and prior and current targets are mapped to a guidance image acquired from a different imaging modality. Biopsy locations are then mapped to the guidance image ( 115 ) and mapped back to the current reference image.

This invention was made with Government support under CooperativeResearch and Development Agreement no. 01864 awarded by the UnitedStates Government Public Health Service. The Government has certainrights in this invention.

BACKGROUND Technical Field

This disclosure relates to systems and methods for planning andperforming interventional procedures and, in particular, systems andmethods for planning and performing repeat interventional procedures.

Description of the Related Art

Biopsies are commonly used to detect cancerous tissues in many areas ofthe body, such as the prostate. However, ultrasound does not accuratelyvisualize prostate cancer lesions. Furthermore, ultrasound-visualizedanatomical landmarks present in the prostate to locate and trackspecific tissue regions are sometimes less reliable than needed.Therefore, prostate tissue is typically sampled randomly andindependently during each repeat biopsy procedure.

Patients that are suspected of having prostate cancer may undergoseveral repeat biopsy procedures without a positive diagnosis of cancerbecause the prostate is sampled randomly each time, without image-basedlesion targeting. This may lead to repeated sampling of the same benignregions of the gland, while potentially missing cancerous regionsoutside the sampled areas. Abnormal findings obtained during oneprocedure are often unable to be tracked over time with repeat samplingin the same location.

deliberate and efficient sampling of previously missed locations is notpossible.

Recent image guidance systems permit registration of magnetic resonanceimaging (“MRI”) scans of the prostate with ultrasound imaging forplanning and guiding prostate biopsies. This allows precise targeting oflesions identified in the MRI, without the need for an MRI in-gantryprocedure. However, a substantial number of prostate cancer lesions andpre-cancerous abnormalities are not visualized on MRI. Theseabnormalities may be detected incidentally on “systematic” biopsies thatare also spatially tracked and recorded on the known systems. However,any biopsy findings recorded in one MRI scan are not able to betransferred efficiently to a subsequent MRI scan and used for planningor targeting purposes.

SUMMARY

In accordance with the present principles, a system for planning andperforming a repeat interventional procedure includes a storage deviceconfigured to store a reference image of a region of a subject having areference image coordinate space. The reference image includes at leastone target area. The storage device may also be configured to store atleast one guidance image of a region of a subject having a guidanceimage coordinate space. The at least one guidance image may be acquiredfrom a different imaging modality than the reference image. Aregistration device may be configured to register the reference imageincluding the at least one target area to the at least one guidanceimage in the guidance image coordinate space. The registration devicemay also be configured to register a mapped guidance image whichincludes the at least one guidance image, the at least one target area,and at least one biopsy location indicating a location that aninterventional procedure was executed, to the reference image in thereference image coordinate space. An image generation device may beconfigured to generate on a display device the mapp

image based on the registration of the reference image and the guidanceimage in the guidance image coordinate space. The image generationdevice may also be configured to generate on a display device a planningimage which includes the reference image and the at least one targetarea and at least one biopsy location based on the registration of themapped guidance image and the reference image in the reference imagecoordinate space.

In another embodiment, a system for planning and performing a repeatinterventional procedure includes a workstation. The workstationincludes one or more processors, memory and an interface. The memoryfurther includes a storage device that may be configured to store areference image of a region of a subject having a reference imagecoordinate space. The reference image includes at least one target area.The storage device may also be configured to store at least one guidanceimage of a region of a subject having a guidance image coordinate space.The at least one guidance image may be acquired from a different imagingmodality than the reference image. A registration module may beconfigured to register the reference image including the at least onetarget area to the at least one guidance image in the guidance imagecoordinate space. The registration module may also be configured toregister a mapped guidance image including the at least one guidanceimage, the at least one target area, and at least one biopsy locationindicating a location that an interventional procedure was executed, tothe reference image in the reference image coordinate space. An imagegeneration module may be configured to generate on a display device themapped guidance image based on the registration of the reference imageand the guidance image in the guidance image coordinate space. The imagegeneration module may also be configured to generate on a display devicea planning image which includes the reference image and the at least onetarget area and at least one biopsy location based on the registrationof the mapped guidance image and the reference image in the referenceimage coordinate space.

In another embodiment, a method for planning and performing a repeatinterventional procedure includes the steps of retrieving a referenceimage of a region of a subject. The reference image includes at leastone target area. At least one guidance image of the region of thesubject may be retrieved. The at least one target area from thereference image may be registered to a coordinate space for the at leastone guidance image and at least one mapped guidance image may begenerated. A first interventional procedure may be performed and biopsylocations where the procedure was executed may be recorded in the atleast one mapped guidance image. The biopsy locations from the mappedguidance images are registered to the reference image in a coordinatespace for the reference image and a planning image may be generated.

The method may include the further steps of retrieving a currentreference image of a region of a subject having at least one currenttarget area and a prior planning image generated from a priorinterventional procedure. The prior planning image may be registeredwith the current reference image and a mapped current reference imagemay be generated having at least one current target area, at least oneprior target area and at least one prior biopsy location. The at leastone current target area, at least one prior target area and at least oneprior biopsy location from the mapped current reference image may beregistered to at least one guidance image having a guidance imagecoordinate space and at least one enhanced guidance image may begenerated. A current interventional procedure may be performed andbiopsy locations are recorded where the current interventional procedurewas executed in the at least one enhanced guidance image. The biopsylocations from the at least one enhanced guidance image may beregistered to the mapped current reference image in a coordinate spacefor the current reference image and an enhanced planning image may begenerated.

These and other objects, features and advantages of the present disclos

become apparent from the following detailed description of illustrativeembodiments thereof, which is to be read in connection with theaccompanying drawings.

BRIEF DESCRIPTION OF DRAWINGS

This disclosure will present in detail the following description ofpreferred embodiments with reference to the following figures wherein:

FIG. 1 is a block/flow diagram showing a system for planning andperforming a repeat interventional procedure in accordance with oneillustrative embodiment;

FIG. 2 is a block/flow diagram showing a system for planning andperforming a repeat interventional procedure in accordance with a secondillustrative embodiment;

FIG. 3 is a flow diagram showing a method for planning and performing arepeat interventional procedure in accordance with one illustrativeembodiment; and

FIG. 4 is a flow diagram showing a method for planning and performing arepeat interventional procedure in accordance with a second illustrativeembodiment.

DETAILED DESCRIPTION OF EMBODIMENTS

In accordance with the present principles, a system for planning andperforming a repeat interventional procedure is provided which registerscurrent targets in a reference image for a first interventionalprocedure to a guidance image acquired from a different imaging modalityfor improved visualization and guidance during the interventionalprocedure. The system may be configured to record biopsy locations andadditional information during the first interventional procedure to theguidance images in the guidance image coordinate space. The system maybe configured to register the biopsy locations and map the biopsylocations on the reference image to provide a planning image for use ina subsequent interventional procedure on the patient.

The system may also be configured to register prior biopsy locations,prior target locations and associated additional information from aprior planning image to a current reference image to provide a mappedcurrent reference image for use in a current interventional procedure.The system may be configured to register the current reference image toa guidance image to provide an enhanced guidance image which includesthe current targets and the prior targets, prior biopsy locations andadditional information from the prior interventional procedure. Thesystem may be further configured to record biopsy locations andadditional information during the current interventional procedure tothe enhanced guidance images in the guidance image coordinate space. Thesystem may be configured to register the biopsy locations for thecurrent interventional procedure and map the biopsy locations on themapped current reference image to provide an enhanced planning image foruse in subsequent interventional procedures.

The system may employ two different imaging modalities at the time ofperforming an interventional procedure and may provide a registrationtherebetween to permit information from prior interventional proceduresto be mapped onto the current images for improved planning andperformance of a current interventional procedure. The system permitsthe user to track specific tissue areas over repeat interventionalprocedures.

It should be understood that the present invention will be described interms of medical systems. However, the teachings of the presentinvention are much broader and in some embodiments, the presentprinciples are employed in quantitatively evaluating complex biologicalor mechanical systems. Furthermore, the present principles areapplicable to internal evaluation procedures of biological systems inall areas of the body such as the lungs, liver, brain, uterus,gastro-intestinal tract, excretory organs, blood vessels, and any othersolid organ tissue, tumor tissue and homogenously or heterogeneouslyenhancing structures of the body. The elements depicted in the Figures.may be implemented in various c

hardware and software and provide functions which may be combined in asingle element or multiple elements.

The functions of the various elements shown in the Figures. can beprovided through the use of dedicated hardware as well as hardwarecapable of executing software in association with appropriate software.When provided by a processor, the functions can be provided by a singlededicated processor, by a single shared processor, or by a plurality ofindividual processors, some of which can be shared. Moreover, explicituse of the term “processor” or “controller” should not be construed torefer exclusively to hardware capable of executing software, and canimplicitly include, without limitation, digital signal processor (“DSP”)hardware, read-only memory (“ROM”) for storing software, random accessmemory (“RAM”), non-volatile storage, etc.

Moreover, all statements herein reciting principles, aspects, andembodiments of the invention, as well as specific examples thereof, areintended to encompass both structural and functional equivalentsthereof. Additionally, it is intended that such equivalents include bothcurrently known equivalents as well as equivalents developed in thefuture (i.e., any elements developed that perform the same function,regardless of structure). Similarly, it will be appreciated that variousprocesses may be substantially represented in computer readable storagemedia and so executed by a computer or processor, whether or not suchcomputer or processor is explicitly shown.

Furthermore, embodiments of the present invention can take the form of acomputer program product accessible from a computer-usable orcomputer-readable storage medium providing program code for use by or inconnection with a computer or any instruction execution system. For thepurposes of this description, a computer-usable or computer readablestorage medium can be any apparatus that may include, store,communicate, propagate, or transport the program for use by or inconnection with the instruc

system, apparatus, or device. The medium can be an electronic, magnetic,optical, electromagnetic, infrared, or semiconductor system (orapparatus or device) or a propagation medium. Examples of acomputer-readable medium include a semiconductor or solid state memory,magnetic tape, a removable computer diskette, a random access memory(RAM), a read-only memory (ROM), a rigid magnetic disk and an opticaldisk. Current examples of optical disks include compact disk-read onlymemory (CD-ROM), compact disk-read/write (CD-R/W), Blu-Ray™ and DVD.

In accordance with the present principles, a system for planning andperforming a repeat interventional procedure is provided. Referring nowto the drawings in which like numerals represent the same or similarelements and initially to FIG. 1, a system 100 includes a storage device111 configured to store a reference image 104 of a region 106 of asubject 108. The reference image 104 may include an MRI image, computedtomography (“CT”) image, a positron emission tomography (“PET”) image,ultrasound image or an image from other imaging modalities known in theart. In a preferred embodiment, the reference image 104 is an MRI image.An MRI image provides a high resolution, non-realtime image with arelatively large field of view, which is advantageous for imageregistration and procedure planning. The reference image 104 includes areference image coordinate space.

The reference image 104 includes at least one target area for a plannedinterventional procedure. For example, in one illustrative embodiment,the interventional procedure is a biopsy, such as a prostate biopsy. Inthis embodiment, the target areas would preferably be a region 106 ofthe subject's prostate where there is an increased suspicion ofcancerous tissue. The system 100 may be configured to show the referenceimage 104 on a display 102. The target areas may be identified by pointlocations in the reference image 104 or 2D or 3D contours in thereference image indicating the location and shape/size of the tai

The storage device 111 may also be configured to store at least oneguidance image 112 of the region 106 of the subject 108. For example, inthe embodiment where the interventional procedure is a prostate biopsy,the guidance images 112 may be images of regions of the subject'sprostate. The guidance images 112 are preferably a different imagingmodality than the reference image 104. The guidance images 112 arepreferably real-time images that are lower resolution and are acquiredat a relatively low cost which is advantageous for live image guidance.In one embodiment, the guidance images are ultrasound images.Alternatives such as magnetic particle imaging may be available insteador in addition. The guidance images 112 include a guidance imagecoordinate space.

The system 100 further includes a registration device 116 that may beconfigured to spatially register each target area in the reference image104 to each guidance image 112 in the guidance image coordinate space.In one embodiment, the registration device 116 may be configured toperform an elastic registration transformation. The registration device116 may be configured to perform the transformation utilizing mutualinformation as a similarity metric and B-splines as an elasticinterpolator, and/or Nelder & Mead's “Downhill Simplex” algorithm foriterative modification of the transformation parameters until thesimilarity metric is maximized. After the transformation is performed bythe registration device 116, the registration device may be configuredto apply the transformation to the coordinates of the target areas inthe reference image 104 which transforms their location in the referenceimage to a corresponding anatomical location in the guidance images 112in the coordinate space of the guidance images. As will be described,the registration device may be configured to perform numerous elasticregistration transformations between images in a reference imagecoordinate space and images in a guidance image coordinate space. Theregistration device 116 may also include a spatial tracking device,preferably an electromagnetic tracking device, to help register thereference image 104 to the

images 112. This tracking may be similar to that employed in the PhilipsInvivo UroNav™ product.

An image generation device 120 may be configured to generate a mappedguidance image 113 on the display 102 based on the registration. Themapped guidance image 113 may include the guidance image 112 and themapped target areas from the reference image 104. The target areas maybe identified in the mapped guidance images 113 by point locations or by2D or 3D contours in the guidance images. The mapped guidance images 113produced by the system permits a practitioner to perform a guidedinterventional procedure, such as a prostate biopsy, in which theguidance images have the target areas mapped thereon to permit clearvisualization of the target areas during performance of the procedure.

The system 100 may be configured to record the locations where theactual biopsies are executed during the interventional procedure in themapped guidance images 113 in the guidance image coordinates. In otherembodiments, the system may be configured to record the locations of theactual biopsies in the guidance images 112. Since targets are oftenbiopsied more than once, the number of biopsy locations may be greaterthan the number of target areas.

The system 100 may be further configured to record additionalinformation 114 related to the reference image 104 or the guidanceimages 112 and the associated interventional procedure that is performedin the storage device 111. The additional information 114 preferablypertains to, and is correlated to, the target areas and biopsy locationsin the mapped guidance images 113 or the target areas in the referenceimage 104. The additional information 114 may include informationrelated to the level of the suspicion of cancer for a target area, suchas a prostate imaging reporting and data system (“PIRADS”) rating. Theadditional information 114 may further include information concet

histopathological findings in the biopsy cores obtained at the biopsylocations such as the tissue type, an indication of whether the tissueis benign or malignant, the type of malignancy, the percentage of cancerin the biopsy core, a Gleason score for the tissue, a summary scorebased on the histopathological findings, etc. The additional information114 may also include information concerning the anatomical location ofthe target areas or biopsy locations

The registration device 116 may be further configured to register thebiopsy locations from each mapped guidance image 113 to the referenceimage 104 in the reference image coordinates. In some embodiments, theregistration device 116 may utilize the transformation between thereference image 104 and the guidance images 112 already obtained inorder to perform an elastic registration transformation between thebiopsy locations in the mapped guidance image to the reference imagecoordinate space. In one embodiment, the registration device 116includes a target counter 118 that may be configured to determine thetotal number of biopsies (N_(prior)) recorded in the mapped guidanceimages 113. The registration device 116 may be configured to retrievethe mapped guidance images 113 and the associated data such as thebiopsy locations (L_(n)).

After the registration transformation T_(guidance) _(→) _(reference) isdetermined by the registration device 116 on the biopsy locations, theregistration device 116 may be configured to apply the transformation tothe coordinates of the biopsy locations in the mapped guidance images113 and any corresponding additional information 114 concerning thebiopsy locations. This transforms their location in the mapped guidanceimage 113 to a corresponding anatomical location in the reference image104 in the coordinate space of the reference image. In one embodiment,the T_(guidance) _(→) _(reference) transformation may also be applied tothe imaging data of the guidance image 112 so that the guidance imagemay be mapped onto the coordinate space of the reference image 104 forretrieval during planning and performance of a subsequent interventionalprocedure. The registration device 116 may be configured to pe

registration for each of the mapped guidance images 113.

An image generation device 120 may be configured to generate a planningimage 122 on the display 102. The planning image 122 includes thereference image 104 which contains the planned targets and the mappedactual biopsy locations from the mapped guidance images 113. The imagegeneration device 120 may also be configured to generate images of anyadditional information 114 on the planning image 122. The imagegeneration device 120 may also generate one or more of the guidanceimages 112 in combination with the planning image 122. The system 100may be configured to store the planning image 122 in the storage device111.

In a preferred embodiment, the system may be configured to store one ormore prior planning images 124 generated during an earlierinterventional procedure in the storage device 111 for use with acurrent interventional procedure. The system may be configured to storea current reference image 126 which is acquired at a later time than theinterventional procedure performed in the prior planning image 124. Thecurrent reference image 126 includes at least one current target areafor the current interventional procedure to be performed on the sameregion of the subject as the associated procedure in the prior planningimage 124. In one embodiment, the current reference image 126 may be anMRI image or another high resolution imaging modality, as previouslydescribed. The current target areas may be identified by point locationsin the current reference image 126 or 2D or 3D contours in the currentreference image indicating the location and shape/size of the target.

The registration device 116 may be configured to register the biopsylocations in the prior planning image 124 to the current reference image126 via a registration, as previously described. The image generationdevice 120 may be configured to generate a mapped current referenceimage 129 which includes the current reference image 126 and the mappedbiopsy locations, targets and additional information 114 from the priorplannin

The registration device 116 may be further configured to register thecurrent target areas, prior target areas, prior biopsy locations andadditional information in the mapped current reference image 129 toguidance images 112 stored in the storage device 111 for the currentinterventional procedure. The image generation device 120 may beconfigured to generate enhanced guidance images 115 on the display 102based on this registration. The enhanced guidance images 115 includesthe guidance images and the mapped current targets and prior biopsylocations, prior targets and additional information from the mappedcurrent reference image 129 in the guidance image coordinate space.

The enhanced guidance images 115 produced by the system permits apractitioner to perform a guided interventional procedure, such as aprostate biopsy, wherein the target areas and the prior biopsies andprior target areas are clearly visualized in the guidance images. Theenhanced guidance images 115 may also include additional information 114related to the prior biopsies or the current targets.

The system 100 may be configured to record the locations where theactual biopsies are executed during the current interventional procedurein the enhanced guidance images 115 in the guidance image coordinates.The system 100 may also be configured to record additional information114 related to the current interventional procedure and the associatedbiopsy locations.

The registration device 116 may be further configured to register thebiopsy locations from the current interventional procedure in theenhanced guidance images 115 to the mapped current reference image 129in the current reference image coordinates. The image generation device120 may also be configured to generate an enhanced planning image 123which includes the mapped current reference image 129 and the mappedactual biopsy locations from the enhanced guidance images 115. Thesystem 100 may be configured to store the enhanced planning image 123 inthe storage device 111 for use as a pi

image in future repeat interventional procedures on the patient. Thestorage device 111 may also be configured to store any image generatedby the image generation device 120 for use in future interventionalprocedures. The system may be configured to show any of the imagesstored in the storage device 111 or generated by the image generationdevice 120 on the display 102. While the systems are generally describedin discrete parts in FIG. 1, the systems and their components may beincorporated into a single system.

In one embodiment, the image generation device 120 may be configured toutilize different visual markers to indicate the additional information114 in the images that are generated, such as different colors orsymbols to indicate the type or severity of the histopathologicalfindings. The image generation device 120 may also be configured to usedifferent colors or symbols to indicate the prior biopsy procedureduring which the prior biopsy locations were obtained. For example, eachtarget area or biopsy location in the generated images may have adistinct color to indicate the time period of the target or biopsylocation.

As shown in FIG. 2, in one embodiment, the system 100 may include aworkstation 101 from which the procedure is supervised and/or managed.The workstation 101 preferably includes one or more processors 127 andmemory 130 for storing programs and applications. In one embodiment, thestorage device 111 may be integrated within the memory 130 of thesystem. The display 102 permits a user to view images and interact withthe workstation 101. In one embodiment, the workstation 101 may includea separate display than the display 102 which shows the reference,guidance and planning images. The system 100 may further include aninterface 128 which may feature a keyboard, mouse, a joystick, a hapticdevice, or any other peripheral or control to permit user feedback fromand interaction with the workstation 101.

The workstation 101 may also include an integrated registration moduli

may be configured to register the images and the target areas, biopsylocations and/or additional information 114 associated therewith todifferent coordinate spaces and provide the same functionality as theregistration device 116 previously described in the embodiment shown inFIG. 1.

The workstation 101 may also include an integrated image generationmodule 121 which may be configured to generate images and provide thesame functionality as the image generation device 120 previouslydescribed in the embodiment shown in FIG. 1.

The system 100 described in FIGS. 1-2 provides the user with imageswhich includes the current target areas as well as the previous targetlocations and biopsy locations. The system 100 may also provide the userwith the additional information 114 concerning the prior interventionalprocedures or the current procedure. The system provides the user withan improved visualization of images of the region and the informationfrom the prior interventional procedures in order to permit the user toplan and perform a repeat, targeted interventional procedure.

The system 100 shown in FIGS. 1-2 may be configured to allow the user tointeract with the visualization such as enabling the user to choosewhich images, targets and prior biopsy locations that the imagegeneration device 120 or image generation module 121 displays in theimages. The system 100 may also be configured to allow the user to inputfurther information associated with each of the targets or biopsylocations. For example, the system may be configured to allow the userto input the further information into the workstation 101 via theinterface 128.

The system 100 may also be configured to receive information from theuser during the performance of the interventional procedure and recordthe information in the storage device 111. For example, the informationinputted by the user during the interventional procedure may include newbiopsy locations, targets and/or associated patholo

The system 100 may also receive new images of the region of the subjectacquired by an imaging device 109, such as an MRI, during theinterventional procedure. The system 100 may be configured to associatethe information inputted during the procedure with the targets or biopsylocations in the images. The system permits the user to perform theinterventional procedure while viewing the various guidance images andadjust the planned procedure, as necessary. The reference and planningimages may be used to plan the current interventional procedure andsubsequent interventional procedures.

Referring to FIG. 3, a method 140 for planning and performing aninterventional procedure is illustratively shown in accordance with thepresent principles. In block 150, a reference image 104 having at leastone target area for an interventional procedure may be retrieved andshown on a display. In block 160, at least one guidance image 112 of theregion of the subject may be retrieved. The at least one guidance image112 may be a different imaging modality than the reference image.

In block 170, the at least one target area from the reference image 104may be registered to the coordinate space of the guidance image and amapped guidance image 113 may be generated which includes the guidanceimage and the target area in the guidance image coordinate space. Inblock 180, the interventional procedure may be performed and the biopsylocations where the actual biopsies are executed are recorded in themapped guidance images 113 in the guidance image coordinates.

In block 190, the biopsy locations from each mapped guidance image 113may be registered to the reference image 104 in the reference imagecoordinates and a planning image 122 may be generated which includes thereference image 104, the planned targets and the mapped actual biopsylocations from the mapped guidance images 113. Additional information114 related to the mapped actual biopsy locations, such as thediagnostic pathology results, may also be registered during this step190. In block 200, th

image 122 may be stored in a storage device 111.

As shown in FIG. 4, in a preferred embodiment, the method furtherincludes the step in block 210 of obtaining a prior planning image 124generated during a prior interventional procedure as well as a currentreference image 126 based on a recent reference image acquired after theprior interventional procedure. The current reference image 126 includesat least one current target area. In block 220, the prior planning image124 may be registered with the current reference image 126 and a mappedcurrent reference image 129 may be generated which includes the currentreference image, the current targets and the mapped prior biopsylocations, prior target locations and associated additional informationfrom the prior planning image 124.

In block 230, the target areas, biopsy locations and associatedadditional information from the mapped current reference image 129 maybe registered to at least one guidance image 112 and enhanced guidanceimages 115 may be generated on a display 102 based on the registrations.The enhanced guidance images 115 include guidance images, the mappedcurrent targets, the prior biopsy locations, prior targets andassociated additional information 114 from the mapped current referenceimage 129 in the guidance image coordinate space. In block 240, acurrent interventional procedure may be performed and the biopsylocations where the actual biopsies are executed may be recorded in theenhanced guidance images 115 in the guidance image coordinates.

In block 250, the biopsy locations for the current interventionalprocedure may be registered with the mapped current reference image 129and an enhanced planning image 123 may be generated which includes themapped current reference image, the mapped actual biopsy locations fromthe current interventional procedure and any additional information fromthe current interventional procedure. In block 260, the enhancedplanning image 123 may be stored in a storage device and may be used insubsequent interventiona

on the subject.

This method for planning and performing a repeat interventionalprocedure permits the user to track specific portions of the region overrepeat procedures and to visualize the locations, targets and results ofthe prior interventional procedures on the recent reference image. Themethod may use two different imaging modalities during eachinterventional procedure and may performs a registration therebetween.This method permits the user to plan the procedure in a targeted mannerand guides the user during the performance of the interventionalprocedure.

It is noted that modifications and variations can be made by personsskilled in the art in light of the above teachings. It is therefore tobe understood that changes may be made in the particular embodiments ofthe disclosure disclosed which are within the scope of the embodimentsdisclosed herein as outlined by the appended claims.

In interpreting the appended claims, it should be understood that:

-   -   a) the word “comprising” does not exclude the presence of other        elements or acts than those listed in a given claim;    -   b) the word “a” or “an” preceding an element does not exclude        the presence of a plurality of such elements;    -   c) any reference signs in the claims do not limit their scope;    -   d) several “means” may be represented by the same item or        hardware or software implemented structure or function; and    -   e) no specific sequence of acts is intended to be required        unless specifically indicated.

Having described preferred embodiments for the system and method forplanning and performing a repeat interventional procedure in a subject(which are intended to be illustrative and not limiting), it is notedthat modifications and variations can b

persons skilled in the art in light of the above teachings. It istherefore to be understood that changes may be made in the particularembodiments of the disclosure disclosed which are within the scope ofthe embodiments disclosed herein as outlined by the appended claims.Having thus described the details and particularity required by thepatent laws, what is claimed and desired protected by Letters Patent isset forth in the appended claims.

1. A system for planning and performing a repeat interventionalprocedure, comprising: a storage device configured to store: a referenceimage of a region of a subject having a reference image coordinatespace, the reference image including at least one target area and amarker at each of the at least one target areas; a series of real-timeguidance image of a region of a subject having a guidance imagecoordinate space, wherein said guidance images are acquired from adifferent imaging modality than the reference image; a registrationdevice configured to register: the reference image including the atleast one target area to the series of real-time guidance image in theguidance image coordinate space; and a series of real-time mappedguidance image comprising the guidance image, the at least one targetarea, and at least one biopsy location indicating a location at which aninterventional procedure was executed, to the reference image in thereference image coordinate space; an image generation device configuredto generate on a display device: the mapped guidance image based on theregistration of the reference image and the guidance images in theguidance image coordinate space, wherein the mapped guidance images eachcomprise the at least one marker at the at least one target area; and aplanning image which includes the reference image and the at least onetarget area and at least one biopsy location based on the registrationof the mapped guidance image and the reference image in the referenceimage coordinate space.
 2. The system as recited in claim 1, wherein:the storage device is further configured to store: a prior planningimage comprising a planning image generated from an earlierinterventional procedure, said prior planning image including at leastone prior target area and at least one prior biopsy location; and acurrent reference image including at least one current target area for acurrent interventional procedure; the registration device is configuredto register: the prior planning image to an image coordinate space ofthe current reference image; and series of real-time enhanced guidanceimages comprising the guidance images, the at least one current targetarea, the at least one prior biopsy location and at least one currentbiopsy location indicating a location at which the currentinterventional procedure was executed, to the current reference image inthe reference image coordinate space; the image generation device isconfigured to generate on the display device: a mapped current referenceimage comprising the current reference image and the at least one priortarget area and at least one prior biopsy location from the priorplanning image; the enhanced guidance image based on registration of theguidance images and the at least one mapped current reference image; andan enhanced planning image, said enhanced planning image including themapped current reference image and the at least one current biopsylocation from the enhanced guidance image based on a registration by theregistration device.
 3. The system as recited in claim 1, wherein thestorage device is configured to store additional information concerningthe reference image and/or the mapped guidance images, said additionalinformation comprising information related to a level of suspicion ofcancer for the at least one target area, histopathological findings ofbiopsy cores obtained at the at least one biopsy locations or anatomicallocation information of the at least one target area or biopsylocations.
 4. The system as recited in claim 3, wherein the imagegeneration device is configured to generate images indicative of theadditional information on the mapped guidance images and/or the planningimage.
 5. The system as recited in claim 1, wherein the system isconfigured to display the reference image and/or the guidance image onthe display device.
 6. The system as recited in claim 1, wherein thesystem is configured to record and store information received from auser during performance of the interventional procedure.
 7. The systemas recited in claim 6, wherein the system is configured to record andstore images from an imaging device during performance of theinterventional procedure.
 8. The system as recited in claim 1, whereinthe reference image is a magnetic resonance imaging image and theguidance images are ultrasound images.
 9. The system as recited in claim1, wherein the interventional procedure comprises a prostate biopsy. 10.A system for planning and performing a repeat interventional procedure,comprising: a workstation including: one or more processors, memory andan interface, wherein said memory includes a storage device that isconfigured to store: a reference image of a region of a subject having areference image coordinate space, the reference image including at leastone target area and a marker at each of the at least one target areas; aseries of real-time guidance images of a region of a subject having aguidance image coordinate space, wherein said guidance images areacquired from a different imaging modality than the reference image; aregistration module configured to register: the reference imageincluding the at least one target area to the series of real-timeguidance image in the guidance image coordinate space; and a series ofmapped guidance image comprising the guidance images, the at least onetarget area, and at least one biopsy location indicating a location atwhich an interventional procedure was executed, to the reference imagein the reference image coordinate space; an image generation moduleconfigured to generate on a display device: the mapped guidance imagebased on the registration of the reference image and the guidance imagein the guidance image coordinate space, wherein the mapped guidanceimages each comprise the at least one marker at the at least one targetarea; and a planning image which includes the reference image and thetarget area and at least one biopsy location based on the registrationof the mapped guidance image and the reference image in the referenceimage coordinate space.
 11. The system as recited in claim 10, wherein:the storage device is further configured to store: a prior planningimage comprising a planning image generated from an earlierinterventional procedure, said prior planning image including at leastone prior target area and at least one prior biopsy location; and acurrent reference image including at least one current target area for acurrent interventional procedure; the registration module is configuredto register: the prior planning image to an image coordinate space ofthe current reference image; and a series of enhanced guidance imagescomprising the guidance images, the at least one current target area,the at least one prior biopsy location and at least one current biopsylocation indicating a location at which the current interventionalprocedure was executed, to the current reference image in the referenceimage coordinate space; the image generation module is configured togenerate on the display device: a mapped current reference imagecomprising the current reference image and the at least one prior targetarea and at least one prior biopsy location from the prior planningimage; the enhanced guidance image based on registration of the guidanceimage and the at least one mapped current reference image; and anenhanced planning image, said enhanced planning image including themapped current reference image and the at least one current biopsylocation from the enhanced guidance images based on a registration bythe registration device.
 12. The system as recited in claim 10, whereinthe storage device is configured to store additional informationconcerning the reference image and/or the mapped guidance images, saidadditional information comprising information related to a level ofsuspicion of cancer for the at least one target area, histopathologicalfindings of biopsy cores obtained at the at least one biopsy locationsor anatomical location information of the at least one target area orbiopsy locations.
 13. The system as recited in claim 10, wherein thesystem is configured to record and store information received from auser during performance of the interventional procedure and/or imagesfrom an imaging device acquired during performance of the interventionalprocedure.
 14. The system as recited in claim 11, wherein the referenceimage is a magnetic resonance imaging image and the guidance images areultrasound image.
 15. A method for planning and performing a repeatinterventional procedure, comprising: retrieving a reference image of aregion of a subject, said reference image having at least one targetarea and a marker at each of the at least one target areas; retrieving aseries of real-time guidance image of the region of the subject, saidguidance image being acquired from a different imaging modality than thereference image; registering the at least one target area from thereference image to a coordinate space for the series of real-timeguidance image and generating a series of real-time mapped guidanceimage, wherein the mapped guidance images each comprise the at least onemarker at the at least one target area; performing a firstinterventional procedure and recording biopsy locations where theprocedure was executed in the mapped guidance image; and registering thebiopsy locations from the mapped guidance images to the reference imagein a coordinate space for the reference image and generating a planningimage.
 16. The method of claim 15, comprising the further steps of:retrieving a current reference image of a region of a subject having atleast one current target area and a prior planning image generated froma prior interventional procedure; registering the prior planning imagewith the current reference image and generating a mapped currentreference image having at least one current target area, at least oneprior target area and at least one prior biopsy location; registeringthe at least one current target area, at least one prior target area andat least one prior biopsy location from the mapped current referenceimage to at least one guidance image having a guidance image coordinatespace and generating a series of real-time enhanced guidance image;performing a current interventional procedure and recording biopsylocations where the current interventional procedure was executed in theenhanced guidance image; and registering the biopsy locations from theenhanced guidance image to the mapped current reference image in acoordinate space for the current reference image and generating anenhanced planning image.
 17. The method of claim 15, comprising thefurther step of retrieving additional information concerning thereference image and/or the mapped guidance images, said additionalinformation comprising information related to a level of suspicion ofcancer for the at least one target area, histopathological findings ofbiopsy cores obtained at the at least one biopsy locations or anatomicallocation information of the at least one target area or biopsylocations.
 18. The method of claim 16, comprising the further step ofgenerating images indicative of the additional information on the mappedguidance images and/or the planning image.
 19. The method of claim 15,comprising the further step of recording and storing informationreceived from a user during performance of the interventional procedureand/or images from an imaging device acquired during performance of theinterventional procedure
 20. The method of claim 15, wherein thereference image is a magnetic resonance imaging image and the guidanceimages are ultrasound images.